A vesicant leak can cause tissue necrosis — stop immediately and follow the extravasation protocol.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is reviewing the complete blood count of a client scheduled for chemotherapy today. Which result would the nurse report to the provider before the dose is given?
Answer: A. An ANC of 900 cells/mm3 indicates neutropenia, and chemotherapy may need to be delayed or the dose reduced to avoid dangerously low counts and infection. The other values listed are within or near normal limits and would not by themselves require holding the dose.
Question 2 of 5
A client with atrial fibrillation is started on warfarin to reduce stroke risk. Which laboratory value does the nurse monitor to evaluate the therapeutic effect?
Answer: A. Warfarin therapy is monitored with the international normalized ratio (INR); a therapeutic INR for atrial fibrillation is generally 2 to 3. The partial thromboplastin time (PTT/aPTT) monitors heparin, not warfarin. Serum potassium and hemoglobin A1c do not measure warfarin effect.
Question 3 of 5
Before initiating a first-generation antipsychotic, the nurse should review which baseline assessment to monitor for a serious cardiac risk?
Answer: A. Many antipsychotics, both typical and atypical, can prolong the QT interval and increase the risk of dysrhythmias, so a baseline electrocardiogram (ECG) to assess the QT interval is important before and during therapy. While weight, glucose, and lipids are monitored for metabolic effects, the ECG specifically addresses the serious cardiac risk of QT prolongation. Monitoring the QT interval helps prevent life-threatening arrhythmias.
Question 4 of 5
A client receiving an IV infusion of an unfractionated heparin drip should have which laboratory value monitored to assess therapeutic effect?
Answer: B. The activated partial thromboplastin time (aPTT) is used to monitor unfractionated heparin therapy, with a therapeutic goal generally 1.5 to 2.5 times the control. The INR/PT monitors warfarin, not heparin.
Question 5 of 5
A client arrives in the emergency department with sudden-onset right-sided weakness and slurred speech that began 90 minutes ago. Which action should the nurse anticipate as the highest priority?
Answer: B. For an acute ischemic stroke within the treatment window, rapid noncontrast CT of the head is the priority to rule out hemorrhage before thrombolytic therapy can be considered. Imaging must precede tPA.
Keep the streak going with more questions like these, each with a full rationale.
What is iv therapy complications?
Telling infiltration (fluid in the tissue), phlebitis (vein inflammation) and infection apart guides the right response. Systemic complications — bloodstream infection, fluid overload and air embolism — are less common but more dangerous. Most local problems are prevented by choosing the right site and catheter, securing the line, and checking the site as often as policy requires.
Key points to remember
- Infiltration: a non-irritating solution leaks into tissue — the site is cool, pale, swollen and tight, and the flow slows.
- Extravasation: a vesicant leaks into tissue — some chemotherapy drugs, vasopressors such as norepinephrine, or concentrated calcium or dextrose — and can cause blistering and tissue death.
- Phlebitis: inflammation of the vein — warmth, redness, tenderness, and sometimes a hard cord along the vein.
- Local infection: redness, swelling and pus at the site; spreading infection adds fever, chills and a rising heart rate.
- Fluid overload: crackles, shortness of breath, rising blood pressure, distended neck veins and weight gain, especially in older adults and in heart or kidney failure.
- Air embolism: sudden shortness of breath, chest pain, low blood pressure and confusion; most often linked to central lines.
Nursing priorities
- Check the IV site per policy — more often with vesicants or confused patients — for color, temperature, swelling and patency.
- Infiltration or phlebitis: stop the infusion, remove the catheter, elevate the arm, apply warm or cold compresses based on the solution, and restart in a new site.
- Extravasation: stop the infusion, leave the catheter in place to aspirate and give the antidote if the protocol says so, then notify the provider.
- Suspected air embolism: clamp the line, turn the patient onto the left side with the head down, give oxygen and call for help.
- Fluid overload: slow the infusion to a keep-vein-open rate, raise the head of the bed, give oxygen and notify the provider.
Patient teaching
- Tell the nurse right away about pain, burning, swelling or leaking at the IV site.
- Keep the IV arm still enough not to pull on the catheter, and do not adjust the pump.
Red flags: report now
- A vesicant leak can cause tissue necrosis — stop immediately and follow the extravasation protocol.
- Pus, fever or red streaks from the site mean infection — remove the catheter, culture as ordered and notify the provider.
- Sudden shortness of breath and chest pain during central line care or removal — suspect air embolism and act now.
References
Clinical references for this topic
